Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

Monday, November 19, 2007

P.S. Thanks to an 'anonymous' comment in the prior light-hearted post we are back to the business of being a purely medical blog and fun will no longer be allowed. We are all physicians here, not people.

25 comments:

Dismissing New Zealands healthcare system (which I'll admit I don't really know anything about) because of this silliness would be like dismissing our free presidential elections because of the silliness that is the electoral college.

i understand that as a student doctor you are just chock full of yummy idealism. good. you'll need. it. hold onto it as long as you can.

first, i DO know a lot about new zealand's health care system. it is a rationed care system. one of my fellow residents had done medical school there and picked up and moved here choosing to practice here to be able to do the kind of interventions that make ER what it is and have the kind of support that makes what we do successful. she will not move back.

also, my grandmother, a native of new zealand, was diagnosed there in 1996 with three vessel coronary disease. she was provided with medical management and told to 'take it easy'. her life expectancy at that time was three years.

she came to california and had her bypass graft and paid for it over 8 years (almost like paying for a car) with the assistance of a generous and excellent CT surgeon.

she just came to my son's birthday with presents and smiles.

this is not a rhetorical excercise... it is basic economics and the reality of a rationed-care system and that IS EXACTLY what people think is a good answer to our current health care 'crisis'.

it is a solution of sorts. kind of like 'logan's run', except rich people will always be able to avoid the 'carousel' and get to quality care.

the proposed solution will make basic care inferior to what it is now and the rate-limiting step will be at the hospital exit. in other words, you might get your bypass graft with your 'free' insurance, but it will be more like being on a list for a liver or kidney transplant than anything else.

new zealand disbanded it's air force 15 years ago. it is the southern hemisphere's socialist utopia as opposed to australia which is much more capitalist driven. the cultures are likewise different, with the kiwis being more British than the Brits and the Aussies a bit more American in their sensibilities.

my point here is that NZ spends nary a penny on national defense as they are surrounded by thousands of miles of oceans and just figure that the US Navy can help out in a pinch. they do not have open borders as there are not a whole bunch of cook islanders dumping onto their beautiful beaches by rafts. their population is relatively stable and stuck, for the most part, in the class they were born in to as that is the nature of socialism.

nevertheless, in this socialist utopia without an immigration problem and with medical care provided by a single payor for all its citizens, NZ must deny admission to a single female who is obese as it might be too much of a 'burden' on their already taxed health system.

again, choose your poison and then stand back and admire what we do in this country where people without insurance and without citizenship WILL, in fact, get their CABG within a day or two of diagnosis and get it done by some of the finest surgeons on the planet.

this is possible not because of government intervention, but in spite of it. however, our capacity is not limitless, and the cracks are showing. the cracks are showing in me and in 'cat and erdoc85 and oldfart and everyone else, who, under EMTALA, have been forced to work for free, many times, for people who, let's be blunt, have done nothing to deserve the money they take continuously out of taxpayer's pockets.

that's one place i agree with NZ and Canada and the UK. they have at least realized that their medical resources are finite. rather than freeing their physicians and experts to provide care and be reimbursed based on the quality and quantity of the care they provide however, they have removed incentive for physician's to work hard.

since no one can operate successfully other than a well-trained surgeon, and no one can stent an occluded coronary other than a well-trained interventional cardiologist the line forms here sir. we sincerely hope that you do not die during your wait but i'm off at five.

i had a patient who was an illegal immigrant and was told in san antonio that she needed a CABG. she was flying under the radar as an illegal, however, and never got her CABG because, in essence, she didn't want anyone in our country knowing she was there and couldn't obviously afford to pay out of pocket for it. she turned up in my state 3 years later having a heart attack.

there was something in the translation that wasn't getting through my head---the interpreter finally explained to me that she "has chest pain every time she walks every day" and "she only came to the hospital today because it didn't go away no matter what". there is only so much you can do for your chest pain and CAD when you go to a free clinic here and there every once in awhile.

taking what 911 said: imagine if every heart patient were like that illegal immigrant due to rationed care....think it can't happen here? well...think again.

rationed care can either limit the poor to working classes access to medical services (the rich will be able to pay) or will increase government's role in our personal lives. If the obesity standard in the New Zealand case were applied in the state I live in, WOW would there be lots of Medicaid dollars freed up...

And here I thought only California had weight restrictions in order to gain entry. Oh, I was confused; it's wrinkles. Can't come here if you have wrinkles.

Unbelievable article, 911, simply unbelievable. I can hear Hillary cackling while wondering out loud why she didn't think of it first. god help us all. Oh, 'scuse me, I just heard my number being called at the DMV.

i type in lower case because my time is too valuable to waste hitting the shift key. notice how i did not put quotes around 'shift' but i did just now to make a point.

three hundred dollars...

typing in all lower case is also a bit like ee cumings and the web-footed balloon man whistled far and wee.

monkey girl. you are more important, and, since you mentioned it, why not let the ladies out for all to see. go ahed and post it on your blog, but then again your dear mother might have a seizure.

my money is that student doctor is a good guy or gal who went straight from undergrad to med school and has a certain exuberance given to youth. student doctor, i am not criticizing and i stand to be corrected, just a guess.

ok. I was semi-impressed by the Logan's Run reference and then I was beginning to think you were somewhat, marginally, almost, maybe, a little bit intelligent with the ee cummings reference... unfortunately it's "goat-footed" not "web-footed". maybe the "web" substitution was some masked reference to the medium through which we are communicating. probably not. I think you are just a little slow.

911: actually started med school about a month before my 31st b-day...and it might interest you that I spent the first 27 or so yrs of life loving rush limbaugh and making fun of treehuggers. then I became one! See, there's still hope left for you!

Back about in 1999 or so, they were building a major thingie in our city which required that many trees be cut down to make room for it. I lived near where the unemployed-type "activists" stationed themselves and chained themselves to trees screaming "where will all the birds go!!!" like freaks for the TV cameras. Across from the demonstrations, there was an ice cream shop, so I'd go there, have a cone and decide whether to laugh or cry. It was good entertainment.

Incidentally, I switched from Democrat to Republican pretty much at that very moment. I could never ever ever be associated with anyone who was remotely like them even though I was also opposed to the "thingie" for completely different reasons (ie really high cost funded c/o our tax dollars).

Bet you a million bucks that student doctor started sleeping with a liberal and he now associates pleasure with tree- hugging. Otherwise, there's no other reason to go from GOP to Democrat. True environmentalists/conservationists can be either GOP or Democrat, but the socialists/vegans have hijacked the conservationist movement making such things unpalatable for at least half of the population.

nurse k: Just curious if you consider yourself a member of any major religion. Because seems like the logic you applied to environmentalism would preclude that.

911: I grew up in a stable, middle class home with parents who loved me and each other. As I got older I realized that I had lived a charmed life. The deck was stacked massively in my favor.

I went from ridiculing people who didn't achieve great things to empathizing with them. I don't think that giving people handouts is the answer to all or even most of their problems. But I also don't think that everyone in our country has an equal opportunity in life.

I realized that one of the big reasons I was a conservative is that it felt so good to be so much smarter than these pussy ass liberals who were always crying about the trees and the poor. (yes, I realize that conservatives aren't the only "holier than thou types out there). I decided to take a critical look at why I believed things like that there should be no universal healthcare and that it was fine for us to go to war when and where we pleased, and affirmative action is unamerican.

I realized that I was a republican because my parents (who I love and respect more than I can say) were republicans. I had gotten a business degree because they were business people. Many of my other choices in life had been made by following the path of least resistance as well. I had no sense of self, no idea of what MY guiding principles in life were. This was all taking place at about age 27 or so.

So I started thinking critically about all the things I KNEW to be true, and ended up a liberal. I also ended up deciding to give up my paying job for a quick decade or so and go to med school. Took me about 4 yrs from making that decision until I got accepted(they don't really make you take org chem to get a marketing degree, unfortunately). And here I am.

More than anything, I just want to live a very examined life. I don't want to go whichever way the wind blows me. I want to look back on all the smart and stupid things I do in my life and think, I did that because (after careful consideration) that really seemed like the way to go. So far this kind of thinking has me in the liberal camp. Granted, at this point I'm almost sure that I'll be a lib forever. But I was also sure I'd never go back to school, and now look at me.

That's all I've got, sorry for the verbal diarrhea (but you did ask :)

Dear Student Doctor, Then we must agree to disagree. To me the liberal position on almost everything of import today is informed by emotion, not reason. To me the liberal is concerned with perception and feelings and not results. To me you fit right into my pigeonhole of 'trustafarian' folks who harbor a lot of guilt at being born with a silver spoon, or at least a stainless-steel spoon, in their mouths (and therefore feel the need to even the playing field by having 'the government' impose fairness from above). Too bad it makes things worse. Again, best of luck.

I am an atheist, yes, although environmentalists are anti-Capitalists whether I am atheist or not.

FYI There are many types of Republicans, only one faction, if you will, are the hard-core fundamentalists. I am a Republican (although the parents and nearly everyone in my state and profession are Democrat) because it has been proven time and time again that "if you want more of something, subsidize it." If you want more illegitimate children, for example, make it easy to have them (free health care, free food, free shelter, free daycare, etc).

So, to me, given the fact that illegitimacy is associated from everything to greater chance of committing crime as an adult to poorer education as a child, encouraging such behavior via handouts seems counter-intuitive if you want to help people. What Student Doctor think is helping people is hurting them.

The best way to help people is to allow them to help themselves by not stifling business and allowing Americans to do what they do best---grow the economy.

There is also the question of defense. The liberals, despite saying they believe in the Constitution, seem to skim over the part where the Federal govt's main job is to organize the defense of the United States. Liberals just will never do as good a job as Republicans at keeping us from getting blown up.

While 911 hits on the head by saying that we should agree to disagree and save our breath, I just have to bite on the "environmentalist are anti-capitalists" line from nurse k.

I am against unrestrained capitalism. I don't think that because something is a profitable result of the free market at work that it is automatically right. I bet if you built a housing development in the middle of Rocky Mountain National Park you could make a shitload of money (who wouldn't want to live there?). Most people (including, i bet, nurse k) Why is it that this is common sense, but drilling for oil in ANWR (for example) seems like such a good idea to the nurse k's of the world?

Just for the record i disagree with pretty much everything else you said too, but don't see the point in further belaboring this liberal/conservative thing.

ANWR is, by and large, in the middle of nowhere for one thing and is not a protected area in the middle of a developed area. If one needs oil, which we always do, especially given the turmoil in the Middle East, it would be best to drill in an unpopulated area, no? I believe, last time I looked, there were fewer than 500 native residents living in the area.

When people are so adamently opposed to drilling for oil when there are so few discernible negatives, it just seems like you're cock-blocking capitalism. Oil is nearly synonymous with evil Republicans for the far left.

I know this isn't related to the theme of the post that closely, but my one view of NZ healthcare was in college on a rugby tour of the North Island. We got in a brawl with some Kiwi farm boys and one guy on our team got a nice shiner that split his eyebrow open and another gash below his eye, both 2-3 cm in length. The local doc, with coke bottle glasses the locals called (no joke) "The Butcher" threw 1 suture in each wound and told the kid to get a beer afterwards.

I love New Zealand. The only place where opossum hunting is "environmentally friendly"